title: Intractable hiccup caused by spinal cord lesions in demyelination disease.
abstract: OBJECTIVE
  This study aimed to summarize the clinical features of patients who presented intractable hiccup (IH) without brain and medulla oblongata (MO) lesions.
  
  
  METHODS
  This study included six patients who were diagnosed with inflammatory demyelinating myelitis, categorized as neuromyelitis optica (NMO), multiple sclerosis (MS), and myelitis. Patients who presented IH with cervical lesions but without MO lesions were also included. Clinical profiles, laboratory data, and magnetic resonance imaging findings were analyzed.
  
  
  RESULTS
  Three out of six patients were diagnosed with NMO, whereas the remaining three were diagnosed with acute myelitis, recurrent myelities, and MS, respectively. The duration of hiccup was from 2 to 23 days (average = 9.33 ± 8.64 days). Five patients (83.33%, patients 1-5) had long segmental lesions and one had a patchy lesion. None of these patients had any MO lesions. Half of them were successfully treated with high-dose methylprednisolone combined with gamma-aminobutyric acid (GABA) inhibitor.
  
  
  CONCLUSIONS
  IH occurred in patients without MO lesion. However, the mechanism remained unclear. Immune factors of demyelinating neuropathy stimulated the hiccup reflex arch. Cervical cord lesions may activate the hiccup center. In general, IH can be controlled by IVMP combined with GABA inhibitor. Unilateral phrenic nerve block may elicit no effect.
authors.affiliation: Department of Neurology, West China Hospital, Sichuan University, Chengdu, China.
authors.forename: Xiao-ting
authors.initials: XT
authors.lastname: Hao
authors.affiliation: Department of Neurology, West China Hospital, Sichuan University, Chengdu, China.
authors.forename: Lu
authors.initials: L
authors.lastname: Wang
authors.affiliation: Department of Neurology, West China Hospital, Sichuan University, Chengdu, China.
authors.forename: Bo
authors.initials: B
authors.lastname: Yan
authors.affiliation: Department of Neurology, West China Hospital, Sichuan University, Chengdu, China.
authors.forename: Hong-yu
authors.initials: HY
authors.lastname: Zhou
mesh_terms: D000293:Adolescent; D000328:Adult; D020278:Demyelinating Autoimmune Diseases, CNS / Q000150:complications* / Q000473:pathology*; D005260:Female; D006606:Hiccup / Q000209:etiology* / Q000473:pathology*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D013118:Spinal Cord Diseases / Q000150:complications* / Q000473:pathology; D055815:Young Adult